Effects of orthopedic treatment (distraction splint) on dentofacial deformities in patients with juvenile idiopathic arthritis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities. OBJECTIVE: To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity. METHODS: The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test. RESULTS: Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1. CONCLUSIONS: The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.

Short Face Dentofacial Deformities: Changes in Social Perceptions, Facial Esthetics, and Occlusion After Bimaxillary and Chin Orthognathic Correction.

The purpose of this study was to document changes in social perceptions and facial esthetics, and document occlusion outcomes in a series of short face (SF) dentofacial deformity (DFD) subjects. The investigators hypothesized that subjects would achieve positive change in social perceptions and facial esthetics, and maintain a long-term corrected occlusion after undergoing bimaxillary and chin osteotomies.A retrospective cohort study was implemented. Photographic records and occlusion parameters were studied preoperatively and >2 years after surgery. The first outcome variable was social perceptions of SF subjects, judged by laypersons. The second outcome variable was facial esthetics, judged by professionals. The third outcome variable was occlusion maintained long-term.Fifteen subjects met inclusion criteria. Mean age at operation was 33 years. Consistent facial contour deformities at presentation included deficient maxillary dental show and downturned oral commissures. As a group, there was improvement (P < 0.05) in 11 of 12 social perceptions, judged by laypersons, all subjects achieved correction of the facial esthetic parameters studied by professionals, and all subjects maintained a favorable occlusion long-term.In SF DFD subjects, bimaxillary and chin surgery proved effective to improve social perceptions, to correct facial contour deformities, and in achieving a long-term corrected occlusion.

Evaluation of dentofacial asymmetry caused by odontomas using panoramic radiographs.

AIMS: To evaluate the presence of dentofacial asymmetry in patients with odontoma by panoramic radiography. METHODS: Panoramic images with odontoma were selected among all panoramic radiographs (3058 patients). Maxillary odontoma was detected in 27 patients while mandibular odontoma was detected in 25 patients. In addition, 30 patients with similar age and gender characteristics were selected as the control group. Skeletal angular, skeletal linear and dental measurements were performed on panoramic radiographs. The odontoma region and the opposite side of the odontoma of the individuals were examined. The dentofacial asymmetry of the odontoma groups was compared with the control group. Paired t-test was used to determine dentofacial asymmetry on the right and left side of the patients with odontoma. The ANOVA test was used for testing the differences among groups. RESULTS: As a result of study, no significant difference was found between the region of the odontoma and the symmetrical region in the maxilla and mandibula (P > 0.05). In the control group, a statistically significant difference was found in the angle between the mandibular canal and the mental foramen, lower incisor size, PFH/CutCat(°), and Co-Mc-Me(°) measurements (P < 0.05). In the maxillary and mandibular odontoma groups, a statistically significant difference was found in the angle between the mandibular canal and the menton, CH (mm), RH (mm), and CrH (mm) in the comparison of the odontoma and the control group (P < 0.05). CONCLUSIONS: No difference was found between the right and left sides of the jaws related with the asymmetry of the maxilla and mandible.

Simultaneous Surgical Correction of Skeletal Class III Dentofacial Deformity During Acute Management of Facial Fractures: Patient Selection and Surgical Technique.

BACKGROUND: Mandibular prognathism is a common dentofacial deformity in Asia. Treatment of such condition may vary from orthodontic camouflage to surgical orthodontics with orthognathic surgery depending on the severity of the condition. Because of the prominent position of the mandible, fractures involving different locations of the mandible commonly occur in maxillofacial trauma. Anatomical reduction of maxillofacial fractures and restoration of the pretraumatic occlusion are the primary goals of acute management of facial fractures. In patients with dentofacial deformity, simultaneous surgical correction of their malocclusion and improvement of their facial aesthetics while providing open treatment to the maxillofacial fractures are rarely reported in the literature. PATIENTS AND METHODS: We reported 3 cases with combined open reduction and internal fixation and surgery-first orthognathic surgery principles to correct class III malocclusion with mandibular prognathism during acute management of maxillofacial fractures. Computer-assisted surgical simulation was used in surgical planning and fabrication of surgical splint. RESULTS: Two patients underwent mandibular osteotomies in addition to open reduction and internal fixation of maxillofacial fractures. One patient had both maxillary and mandibular osteotomies during facial fracture repair. Class I occlusion with satisfactory facial profile was achieved in all 3 cases. CONCLUSIONS: Careful patient selection with presurgical planning using computer-assisted surgical simulation is essential in achieving successful outcomes in correcting dentofacial deformities while managing maxillofacial fractures. This combined technique is a viable option in the surgical management of facial fractures in patients with dentofacial deformities.

Accuracy of Orthognathic Surgical Outcomes Using 2- and 3-Dimensional Landmarks-The Case for Apples and Oranges?

PURPOSE: To verify predicted versus obtained surgical movements in 2-dimensional (2D) and 3-dimensional (3D) measurements and compare the equivalence between these methods. MATERIALS AND METHODS: A retrospective observational study of bimaxillary orthognathic surgeries was performed. Postoperative cone-beam computed tomographic (CBCT) scans were superimposed on preoperative scans and a lateral cephalometric radiograph was generated from each CBCT scan. After identification of the sella, nasion, and upper central incisor tip landmarks on 2D and 3D images, actual and planned movements were compared by cephalometric measurements. One-sample t test was used to statistically evaluate results, with expected mean discrepancy values ranging from 0 to 2 mm. Equivalence of 2D and 3D values was compared using paired t test. RESULTS: The final sample of 46 cases showed by 2D cephalometry that differences between actual and planned movements in the horizontal axis were statistically relevant for expected means of 0, 0.5, and 2 mm without relevance for expected means of 1 and 1.5 mm; vertical movements were statistically relevant for expected means of 0 and 0.5 mm without relevance for expected means of 1, 1.5, and 2 mm. For 3D cephalometry in the horizontal axis, there were statistically relevant differences for expected means of 0, 1.5, and 2 mm without relevance for expected means of 0.5 and 1 mm; vertical movements showed statistically relevant differences for expected means of 0, 0.5, 1.5 and 2 mm without relevance for the expected mean of 1 mm. Comparison of 2D and 3D values displayed statistical differences for the horizontal and vertical axes. CONCLUSIONS: Comparison of 2D and 3D surgical outcome assessments should be performed with caution because there seems to be a difference in acceptable levels of accuracy between these 2 methods of evaluation. Moreover, 3D accuracy studies should no longer rely on a 2-mm level of discrepancy but on a 1-mm level.

Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity.

PURPOSE: To compare the condylar volume of patients with unilateral condylar hyperplasia (UCH) with that of patients with a Class III skeletal relation. MATERIALS AND METHODS: Twenty cone-beam computed tomograms of patients were analyzed. Images were divided into 2 groups: 10 from patients with transverse asymmetry of the face and 10 from patients with a Class III facial deformity. Patients' ages ranged from 15 to 30 years. Volumetric data were reconstructed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, CA). This software measured the condylar volume above the deepest point of the sigmoid notch, the lower arch midline deviation, and the overjet. RESULTS: The condyle with hyperplasia exhibited the largest volume (1.97 ± 0.52 cm3) and a statistically significant difference compared with the contralateral condyle (χ2 = 14.30; P < .01). The Class III condyle exhibited relative symmetry of volume between the left and right sides. These condyles exhibited a larger volume compared with the non-hyperplastic condyles in the UCH group, with a statistically significant difference (χ2 = 6.22; P = .013; χ2 = 5.50; P = .019). CONCLUSIONS: Hyperplastic condyles were similar in volume to the condyles of patients with mandibular prognathism, suggesting that patients with a Class III skeletal relation could exhibit bilateral condylar hyperplasia.

Accuracy of Different Modalities to Record Natural Head Position in 3 Dimensions: A Systematic Review.

PURPOSE: Three-dimensional (3D) images are taken with positioning devices to ensure a patient's stability, which, however, place the patient's head into a random orientation. Reorientation of images to the natural head position (NHP) is necessary for appropriate assessment of dentofacial deformities before any surgical planning. The aim of this study was to review the literature systematically to identify and evaluate the various modalities available to record the NHP in 3 dimensions and to compare their accuracy. MATERIALS AND METHODS: A systematic literature search of the PubMed, Cochrane Library and Embase databases, with no limitations on publication time or language, was performed in July 2015. The search and evaluations of articles were performed in 4 rounds. The methodologies, accuracies, advantages, and limitations of various modalities to record NHP were examined. RESULTS: Eight articles were included in the final review. Six modalities to record NHP were identified, namely 1) stereophotogrammetry, 2) facial markings along laser lines, 3) clinical photographs and the pose from orthography and scaling with iterations (POSIT) algorithm, 4) digital orientation sensing, 5) handheld 3D camera measuring system, and 6) laser scanning. Digital orientation sensing had good accuracy, with mean angular differences from the reference within 1° (0.07 ± 0.49° and 0.12 ± 0.54°, respectively). Laser scanning was shown to be comparable to digital orientation sensing. The method involving clinical photographs and the POSIT algorithm was reported to have good accuracy, with mean angular differences for pitch, roll, and yaw within 1° (-0.17 ± 0.50°). Stereophotogrammetry was reported to have the highest reliability, with mean angular deviations in pitch, roll, and yaw for active and passive stereophotogrammetric devices within 0.1° (0.004771 ± 0.045645° and 0.007572 ± 0.079088°, respectively). CONCLUSIONS: This systematic review showed that recording the NHP in 3 dimensions with a digital orientation sensor has good accuracy. Laser scanning was found to have comparable accuracy to digital orientation sensing, but routine clinical use was limited by its high cost and low portability. Stereophotogrammetry and the method using a single clinical photograph and the POSIT algorithm were potential alternatives. Nevertheless, clinical trials are needed to verify their applications in patients. Preferably, digital orientation sensor should be used as a reference for comparison with new proposed methods of recording the NHP in future research.

Radiology of Cleft Lip and Palate: Imaging for the Prenatal Period and throughout Life.

Recent advances in prenatal imaging have made possible the in utero diagnosis of cleft lip and palate and associated deformities. Postnatal diagnosis of cleft lip is made clinically, but imaging still plays a role in detection of associated abnormalities, surgical treatment planning, and screening for or surveillance of secondary deformities. This article describes the clinical entities of cleft lip with or without cleft palate (CLP) and isolated cleft palate and documents their prenatal and postnatal appearances at radiography, ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT). Imaging protocols and findings for prenatal screening, detection of associated anomalies, and evaluation of secondary deformities throughout life are described and illustrated. CLP and isolated cleft palate are distinct entities with shared radiologic appearances. Prenatal US and MR imaging can depict clefting of the lip or palate and associated anomalies. While two- and three-dimensional US often can depict cleft lip, visualization of cleft palate is more difficult, and repeat US or fetal MR imaging should be performed if cleft palate is suspected. Postnatal imaging can assist in identifying associated abnormalities and dentofacial deformities. Dentofacial sequelae of cleft lip and palate include missing and supernumerary teeth, oronasal fistulas, velopharyngeal insufficiency, hearing loss, maxillary growth restriction, and airway abnormalities. Secondary deformities can often be found incidentally at imaging performed for other purposes, but detection is necessary because they may have considerable implications for the patient.

Evaluation of the Upper Airway Morphology: The Role of Cone Beam Computed Tomography.

Cone beam computed tomography (CBCT) has several applications in dentomaxillofacial diagnosis. Frequently, the imaged volume encompasses the upper airway. This article provides a systematic approach to airway analysis and the implications of the anatomic and pathologic alterations. It discusses the role of CBCT in management of obstructive sleep apnea (OSA) patients. This paper also highlights technological advances that combine CBCT imaging with computational modeling of the airway and the potential clinical applications of such technologies.

Metopic frontal suture in a patient with severe dentofacial deformity undergoing bimaxillary surgery.

Six cranial fontanelles are present in newborns along with cranial sutures. Cranial sutures are a synarthrosis type of joints that occur in the skull after closure of fontanelles. Because of ossification up to 24 months, all fontanelles should be closed. Normal frontal bone consists of only frontonasal, frontozygomatic, frontomaxillaris, frontolacrimalis, and main coronal sutures. Metopic frontal suture occurs very rarely in adults. Some metopic frontal sutures might be related to genetic or general disorders or perhaps are related to an improper ossification. In some cases, it persists as a complete suture extending from the nasion to the anterior angle of the bregma, and this condition is called metopism, or metopic suture. In this article, we present a patient with metopic frontal suture diagnosed accidentally during preparation for bimaxillary orthognathic surgery.

Deep Learning-Based Facial and Skeletal Transformations for Surgical Planning.

The increasing application of virtual surgical planning (VSP) in orthognathic surgery implies a critical need for accurate prediction of facial and skeletal shapes. The craniofacial relationship in patients with dentofacial deformities is still not understood, and transformations between facial and skeletal shapes remain a challenging task due to intricate anatomical structures and nonlinear relationships between the facial soft tissue and bones. In this study, a novel bidirectional 3-dimensional (3D) deep learning framework, named P2P-ConvGC, was developed and validated based on a large-scale data set for accurate subject-specific transformations between facial and skeletal shapes. Specifically, the 2-stage point-sampling strategy was used to generate multiple nonoverlapping point subsets to represent high-resolution facial and skeletal shapes. Facial and skeletal point subsets were separately input into the prediction system to predict the corresponding skeletal and facial point subsets via the skeletal prediction subnetwork and facial prediction subnetwork. For quantitative evaluation, the accuracy was calculated with shape errors and landmark errors between the predicted skeleton or face with corresponding ground truths. The shape error was calculated by comparing the predicted point sets with the ground truths, with P2P-ConvGC outperforming existing state-of-the-art algorithms including P2P-Net, P2P-ASNL, and P2P-Conv. The total landmark errors (Euclidean distances of craniomaxillofacial landmarks) of P2P-ConvGC in the upper skull, mandible, and facial soft tissues were 1.964 ± 0.904 mm, 2.398 ± 1.174 mm, and 2.226 ± 0.774 mm, respectively. Furthermore, the clinical feasibility of the bidirectional model was validated using a clinical cohort. The result demonstrated its prediction ability with average surface deviation errors of 0.895 ± 0.175 mm for facial prediction and 0.906 ± 0.082 mm for skeletal prediction. To conclude, our proposed model achieved good performance on the subject-specific prediction of facial and skeletal shapes and showed clinical application potential in postoperative facial prediction and VSP for orthognathic surgery.

Deep learning classification performance for diagnosing condylar osteoarthritis in patients with dentofacial deformities using panoramic temporomandibular joint projection images.

OBJECTIVE: The present study aimed to assess the consistencies and performances of deep learning (DL) models in the diagnosis of condylar osteoarthritis (OA) among patients with dentofacial deformities using panoramic temporomandibular joint (TMJ) projection images. METHODS: A total of 68 TMJs with or without condylar OA in dentofacial deformity patients were tested to verify the consistencies and performances of DL models created using 252 TMJs with or without OA in TMJ disorder and dentofacial deformity patients; these models were used to diagnose OA on conventional panoramic (Con-Pa) images and open (Open-TMJ) and closed (Closed-TMJ) mouth TMJ projection images. The GoogLeNet and VGG-16 networks were used to create the DL models. For comparison, two dental residents with < 1 year of experience interpreting radiographs evaluated the same condyle data that had been used to test the DL models. RESULTS: On Open-TMJ images, the DL models showed moderate to very good consistency, whereas the residents' demonstrated fair consistency on all images. The areas under the curve (AUCs) of both DL models on Con-Pa (0.84 for GoogLeNet and 0.75 for VGG-16) and Open-TMJ images (0.89 for both models) were significantly higher than the residents' AUCs (p < 0.01). The AUCs of the DL models on Open-TMJ images (0.89 for both models) were higher than the AUCs on Closed-TMJ images (0.72 for both models). CONCLUSIONS: The DL models created in this study could help residents to interpret Con-Pa and Open-TMJ images in the diagnosis of condylar OA.

Initial radiological signs of dentofacial deformity in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. TMJ arthritis in growing individuals can cause deformation of facial skeleton (dentofacial deformity) and TMJ components (TMJ deformity). Treatment outcome hinges on early initiation of anti-inflammatory treatment and orthopaedic treatment with dental splints. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. We retrospectively studied 96 patients with JIA and 20 non-JIA controls to identify the initial radiological signs of JIA-induced dentofacial deformity leading to initiation of orthopaedic treatment. We found that initial radiological signs of dentofacial deformities were subtle and characterized by minor mandibular asymmetry and occlusal plane steepening. Radiological findings of TMJ deformity associated with initial dentofacial deformity were frequent and characterized by condylar articular surface flattening (OR 8.42), condylar subcortical cyst (OR 5.94), condylar surface erosion (OR 5.38) and condylar deviation in form (OR 25.39). Radiological signs of TMJ deformity were also documented in TMJs considered "healthy" during initial clinical and radiological examination. This study presents new knowledge of importance for early diagnosis of dentofacial deformity in JIA. Early diagnosis of dentofacial deformity is important as treatment outcome is greatly influenced by timely initiation.

Condyle modeling stability, craniofacial asymmetry and ACTN3 genotypes: Contribution to TMD prevalence in a cohort of dentofacial deformities.

Craniofacial asymmetry, mandibular condylar modeling and temporomandibular joint disorders are common comorbidities of skeletally disproportionate malocclusions, but etiology of occurrence together is poorly understood. We compared asymmetry, condyle modeling stability and temporomandibular health in a cohort of 128 patients having orthodontics and orthognathic surgery to correct dentofacial deformity malocclusions. We also compared ACTN3 and ENPP1 genotypes for association to clinical conditions. Pre-surgical posterior-anterior cephalometric and panometric radiographic analyses; jaw pain and function questionnaire and clinical examination of TMD; and SNP-genotype analysis from saliva samples were compared to assess interrelationships. Almost half had asymmetries in need of surgical correction, which could be subdivided into four distinct morphological patterns. Asymmetric condyle modeling between sides was significantly greater in craniofacial asymmetry, but most commonly had an unanticipated pattern. Often, longer or larger condyles occurred on the shorter mandibular ramus side. Subjects with longer ramus but dimensionally smaller condyles were more likely to have self-reported TMD symptoms (p = 0.023) and significantly greater clinical diagnosis of TMD (p = 0 .000001), with masticatory myalgia most prominent. Genotyping found two significant genotype associations for ACTN3 rs1671064 (Q523R missense) p = 0.02; rs678397 (intronic SNP) p = 0.04 and one significant allele association rs1815739 (R577X nonsense) p = 0.00. Skeletal asymmetry, unusual condyle modeling and TMD are common and interrelated components of many dentofacial deformities. Imbalanced musculoskeletal functional adaptations and genetic or epigenetic influences contribute to the etiology, and require further investigation.

Does facial appearance of dentofacial deformity influence the need for orthognathic surgery: The Malaysian perception.

Aim: This study evaluates perception toward facial appearance in dentofacial deformity and the need for orthognathic surgery among the public with and without dental backgrounds. Materials and Methods: A questionnaire consisting of 12 facial photographs of cases with dentofacial deformity or malocclusion in varying severity was used. A hundred individuals were selected to answer the questionnaire. The perception of facial appearance (FAS), treatment need score (TNS), and knowledge regarding dentofacial deformity were used for the evaluation. Results: Significant differences were found between dental and non-dental when the respondents' knowledge in all the questionnaire items ([Formula: see text].05) was assessed. However, no significant difference was found in the mean of FAS and TNS in all the presented cases (normal, borderline, severe). Pearson correlation between perceived FAS and TNS was statistically negative for severe and normal cases, whereby a decrease in FAS for severe cases showed an increase in TNS, and an increase in FAS for normal cases showed a decrease in TNS. Conclusion: Respondents with dental background had sound knowledge of dentofacial deformity. A poorly attractive respondent with dentofacial deformity showed a greater need for orthognathic surgery.

Staged therapeutic approach for rehabilitation of severe asymmetric Class II dentofacial deformity secondary to long standing unilateral temporomandibular joint ankylosis.

Despite being one of the most pervasive debilitating skeletal problems in the craniofacial region, surgical-orthodontic management of long-standing asymmetric Class II dentofacial deformities is often a unique challenge posed to the clinicians. This case report describes the encouraging results of systematically sequenced and staged therapeutic approach adopted for successful rehabilitation of an adult patient with asymmetric Class II dentofacial deformity with mandibular micrognathia secondary to unilateral TMJ ankylosis. Concurrent gap arthroplasty and bilateral distraction of mandibular body were performed during the first operation for functional restoration of mandibular movements and correction of mandibular micrognathia and associated asymmetry. After 13 months of post-distraction orthodontic treatment, Le Fort I osteotomy for inferior repositioning and sagittal advancement of maxilla was performed during the second operation, in conjunction with adjunctive alloplastic reconstruction of inferior border of mandible for optimization of facial aesthetics. Postsurgical orthodontic detailing facilitated achievement of stable, balanced interdigitation. The total active treatment period was 29 months. After treatment, both the skeletal disharmony and the functional stability were significantly improved with establishment of functional occlusion. The morphological and functionally acceptable results were reasonably well-maintained during three-year follow-up. The merits of mandibular osteodistraction vs. conventional mandibular orthognathic surgery and the potential advantages of staged surgical approach are discussed.

Identification of 'Point A' as the prevalent source of error in cephalometric analysis of lateral radiographs.

Deviations in measuring dentofacial components in a lateral X-ray represent a major hurdle in the subsequent treatment of dysgnathic patients. In a retrospective study, we investigated the most prevalent source of error in the following commonly used cephalometric measurements: the angles Sella-Nasion-Point A (SNA), Sella-Nasion-Point B (SNB) and Point A-Nasion-Point B (ANB); the Wits appraisal; the anteroposterior dysplasia indicator (APDI); and the overbite depth indicator (ODI). Preoperative lateral radiographic images of patients with dentofacial deformities were collected and the landmarks digitally traced by three independent raters. Cephalometric analysis was automatically performed based on 1116 tracings. Error analysis identified the x-coordinate of Point A as the prevalent source of error in all investigated measurements, except SNB, in which it is not incorporated. In SNB, the y-coordinate of Nasion predominated error variance. SNB showed lowest inter-rater variation. In addition, our observations confirmed previous studies showing that landmark identification variance follows characteristic error envelopes in the highest number of tracings analysed up to now. Variance orthogonal to defining planes was of relevance, while variance parallel to planes was not. Taking these findings into account, orthognathic surgeons as well as orthodontists would be able to perform cephalometry more accurately and accomplish better therapeutic results.

Digital platform for planning facial asymmetry orthodontic-surgical treatment preparation.

Dentofacial deformities usually are surgically treated, and 3D virtual planning has been used to favor accurate outcomes. Cases reported in the present article show that orthognathic surgery carried out to correct facial asymmetries does not comprise only one treatment protocol. 3D virtual planning might be used for surgical planning, but it should also be used to diagnose the deformity, thus allowing for an analysis of the best-recommended possibilities for the orthodontic preparation that suits each individual case.

Dental anomalies in pediatric patients with familial adenomatous polyposis.

Familial adenomatous polyposis patients often present with non-malignant extra-intestinal manifestations which include dental anomalies that may be evident prior to the appearance of the colonic adenomas. The aims of this study were to describe the prevalence and type of dental anomalies and the relationships between gene mutations and dental anomalies in these patients. Twenty-two pediatric familial adenomatous polyposis patients and 46 controls, who were age and gender matched participated. Familial adenomatous polyposis patient's had a dental examination with panoramic radiograph and medical record review for age at diagnosis, the presence of the adenomatous polyposis coli gene mutation, and determination of other extra-intestinal manifestations on the body. The control group was identified from a retrospective chart review and selected if there was a current panoramic radiograph. The only significant difference between familial adenomatous polyposis patients and controls were the presence of jaw osteomas and sclerosis (p = .0001). Patients with a mutation in, or upstream of codon 1309 had a higher frequency of osteomas (77.8%) and jaw-bone sclerosis (44.4%), and 77% of these had at least one dental anomaly. This preliminary study showed an association between a genetic variant at, or upstream of codon 1309, and radiographic dental anomalies.

Assessment of dentofacial growth deviation in juvenile idiopathic arthritis: Reliability and validity of three-dimensional morphometric measures.

INTRODUCTION: Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. METHODS: The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. RESULTS: Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a "high recommendation" score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were "moderately recommended" and five received a "somewhat recommendation" score. CONCLUSION: Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.